ABSTRACT Recipients of a kidney transplant from an African-American deceased donor have worse outcomes than their counterparts receiving an organ from a White deceased donor. The extent to which this is due to the presence of high-risk APOL1 genotypes in African-American donors is unknown. Several recent studies have found a positive association between high-risk APOL1 genotypes and graft failure, but these have been based on relatively few events, have come primarily from a few large centers, and have not analyzed donor-recipient pairs. The proposed studies will investigate the association of a kidney donor's APOL1 status with recipient outcomes. We will also study estimate the impact of APLO1 status on living donor outcomes. We have assembled a consortium including 6 organ procurement organizations covering 7 states in the Upper Midwest, 123 recovering hospitals, 25 transplant centers and collaborators in transplant surgery, transplant nephrology, epidemiology and genetics to achieve these goals. These findings will provide a greater understanding of the impact of the presence of high-risk APOL1 variants in both recipients and living donors. These data are needed for informed decision-making for recipients, potential living donors, and their caregivers. Both the relative and absolute risk of clinically significant events associated with high-risk APOL1 variants will be estimated with much greater precision that previous studies, allowing more informed decisions on acceptance of specific organs for transplantation.